A7039 — Filter, non disposable, used with positive airway pressure device
HCPCS Level II A-code · short descriptor: “Filter, non disposable w pap”
- Code system
- HCPCS Level II
- Family
- A — Medical & surgical supplies, ambulance
- Medicare coverage status
- Carrier judgment — coverage decided by the DME MAC
- DMEPOS payment category
- Inexpensive or routinely purchased
- Prior authorization
- Not on Medicare required-PA list
- Face-to-face & WOPD
- Not on the required list
- MUE unit limit
- 1
- Status
- Active (HCPCS Level II October 2026)
Prior authorization
Not on the Medicare required-PA list (CMS Required Prior Authorization List — 74 items in force on 2026-10-26; 8 more from 2026-10-28; sources: CMS list updated 2026-01-13, CMS-6109-N (91 FR 47972)). Medicare Advantage and commercial plans set their own prior-authorization rules for this code — verify per plan before delivery.
Order readiness — what the written order must contain
Every Medicare DMEPOS claim needs a Standard Written Order with all six elements (42 CFR 410.38(d)):
- Beneficiary name or Medicare Beneficiary Identifier (MBI) (42 CFR 410.38(d)(1)(i)(A))
- General description of the item (42 CFR 410.38(d)(1)(i)(B))
- Quantity to be dispensed, if applicable (42 CFR 410.38(d)(1)(i)(C))
- Order date (42 CFR 410.38(d)(1)(i)(D))
- Treating practitioner name or NPI (42 CFR 410.38(d)(1)(i)(E))
- Treating practitioner signature (42 CFR 410.38(d)(1)(i)(F))
Not on the F2F/WOPD list (CMS Required F2F & WOPD List — 83 items in force on 2026-10-26; 22 more from 2026-10-28; sources: CMS list effective 2026-04-13 (91 FR 1250), CMS-6109-N (91 FR 47972)). The standard written order must reach the supplier before claim submission.
Blank requirements checklist only — MyMedi-AI never collects or stores completed orders.
A7039 Medicare fee schedule (October 2026)
NU — New purchase Inexpensive or routinely purchased
Medicare allowable ranges from $7.39 to $13.64 depending on state and rural status.
| State | Non-rural | Rural |
|---|---|---|
| AK | $11.82 | — |
| AL | $7.57 | $12.22 |
| AR | $7.57 | $12.22 |
| AZ | $7.68 | $13.64 |
| CA | $7.64 | $13.64 |
| CO | $7.73 | $12.22 |
| CT | $7.67 | $13.64 |
| DC | $7.59 | $12.81 |
| DE | $7.59 | $13.64 |
| FL | $7.57 | $12.22 |
| GA | $7.57 | $12.22 |
| HI | $12.34 | — |
| IA | $7.39 | $13.64 |
| ID | $7.73 | $13.64 |
| IL | $7.87 | $12.81 |
| IN | $7.87 | $13.27 |
| KS | $7.39 | $13.64 |
| KY | $7.57 | $12.22 |
| LA | $7.57 | $12.27 |
| MA | $7.67 | $13.64 |
| MD | $7.59 | $12.81 |
| ME | $7.67 | $13.64 |
| MI | $7.87 | $13.19 |
| MN | $7.39 | $13.34 |
| MO | $7.39 | $13.64 |
| MS | $7.57 | $12.22 |
| MT | $7.73 | $13.64 |
| NC | $7.57 | $12.22 |
| ND | $7.39 | $13.64 |
| NE | $7.39 | $13.64 |
| NH | $7.67 | $13.64 |
| NJ | $7.59 | $13.64 |
| NM | $7.68 | $12.22 |
| NV | $7.64 | $13.64 |
| NY | $7.59 | $13.64 |
| OH | $7.87 | $12.81 |
| OK | $7.68 | $12.22 |
| OR | $7.64 | $13.64 |
| PA | $7.59 | $13.64 |
| PR | $13.05 | — |
| RI | $7.67 | $13.64 |
| SC | $7.57 | $12.22 |
| SD | $7.39 | $13.64 |
| TN | $7.57 | $12.22 |
| TX | $7.68 | $12.22 |
| UT | $7.73 | $13.64 |
| VA | $7.57 | $12.81 |
| VI | $13.60 | — |
| VT | $7.67 | $13.64 |
| WA | $7.64 | $13.64 |
| WI | $7.87 | $13.27 |
| WV | $7.57 | $12.81 |
| WY | $7.73 | $13.64 |
Unit limit (MUE)
Medicare's Medically Unlikely Edit caps A7039 at 1 unit per date of service (absolute). Units above the MUE deny — typically as CO-151. Rationale: Published Contractor Policy.
Common denial codes to watch
Related A-codes
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